Arterial microanastomoses on the reverse flow of the internal carotid artery reverse flow: an extreme solution in free-flap revascularisation. How we do it.

Microvascular free tissue transfer in head and neck reconstruction requires suitable recipient vessels, which are frequently compromised by prior surgery, radiotherapy, or size of the tumour. A surgical description of an arterial free flap pedicle anastomosis on the reverse internal carotid arterial flow in a vessel-depleted neck is presented. A 66-year-old male with a relapse of hypopharyngeal squamous cell carcinoma previously treated with both surgical and radiation therapy for carcinoma of the tongue and the larynx was successfully reconstructed using a free forearm flap with reverse internal carotid arterial flow. The involvement of the carotid glomus and prior surgery excluded the other vessels as recipients. The forearm free flap survived without any complications. This procedure can be considered an alternative rescue technique for salvage reconstruction in a vessel-depleted neck.